Rush Limbaugh, Sandra Fluke and Why is Contraception Part of Health Insurance Anyway?

From what's being reportedRush Limbaugh said about Sandra Fluke he owes the young lady an apology. Just on the basic issue of good manners if nothing else.

However, that's not the part of the larger story that interests me. I'm simply terribly confused as to why anyone at all would want contraception to be part of a heath care insurance scheme. I've touched on it before, here. Ezra Klein outlines Ms. Fluke's position here.

Fluke came to Georgetown University interested in contraceptive coverage: She researched the Jesuit college’s health plans for students before enrolling, and found that birth control was not included. “I decided I was absolutely not willing to compromise the quality of my education in exchange for my health care,” says Fluke, who has spent the past three years lobbying the administration to change its policy on the issue. The issue got the university president’s office last spring, where Georgetown declined to change its policy.

Fluke says she would have used the hearing to talk about the students at Georgetown that don’t have birth control covered, and what that’s meant for them. “I wanted to be able to share their stories,” she says. “My testimony would have been about women who have been affected by their policy, who have medical needs and have suffered dire consequences.. . .The committee did not get to hear real stories I had to share, about actual women who have been dramatically affected by this policy.”

I asked Fluke what she’s learned about reproductive health politics over the past few months, as the nation has debated the role of contraceptives coverage in health reform. “Sadly, I think what I have learned is how willing some members of our government are to play political football with women’s health,” she says. “That has been heartbreaking to watch.

Fluke plans to continue working on the issue to ensure that the health reform regulations do eventually require Georgetown University to provide birth control to its students.

Just for a moment, for the purposes of my argument here, leave aside whether a Jesuit organisation really should be forced to provide contraception for it students. Leave aside the point that Ms. Fluke herself makes about preferring to be educated by the Jesuits without birth control rather than get the contraception but be educated elsewhere (and there was me thinking that this really was all about choices).

I'm interested purely and simply in the use of an insurance model as a method of providing this contraception. For it's very difficult indeed to think of something less suited to such a financing model.

Now don't get me wrong: I've nothing against contraception itself: I've far too much interest in a sporting sex life for me to want it to not be generally available. Hmm, at my age perhaps I should revise that to I did so I see no reason at all why the youth of today should be denied the pleasure and fun that I enjoyed.

I'm also just fine with the unmarried having sex (see preceding paragraph), lots of it, with contraception being available to all who want it, of the type they want and when they want it. But what I don't understand is this insistence that it should be health care insurance that pays for it.

Insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss.

This just isn't what we're doing with contraception. It is what we're doing when we take out insurance against large health care problems. Having a car crash, getting cancer, needing a transplant. These are things that happen to a minority of us so we pool the risks. That contingent loss is so huge that we really do want to insure the loss away. This also applies to hurricane insurance, flood, fire and so on.

But something that most of the women of the country are going to use for a significant portion of their adult lives just isn't suitable for an insurance model. Leave aside those who don't have heterosexual sex at all (a significant minority, yes, but a minority all the same) and with rare enough exceptions the vast majority of women in the country are going to spend a couple of decades of their lives managing their fertility. Such management is not an unexpected thing, it is not uncertain, it's just part and parcel of what the 21 st century allows us to do.

It's very definitely part of health care, I agree with that idea. It's certainly something that needs to be monitored by the health care system, that's also true. But it's still not one of those things that is amenable to insurance as its financing method.

Just to make up some numbers, say that the preferred method costs $30 a month. But that having the contraception covered by insurance will raise the premium by $50 a month. The insurance company does, after all, have certain costs associated with taking the premium then paying it straight back out again to buy the pill. Why would anyone do this? Why not purchase the pill for $30, stiff the insurance company bureaucrats the $20 and spend it on a couple of cocktails at a place where you might meet someone who thinks that your being a contraceptive user is a good idea?

It's this insistence that it all be paid for through insurance premiums that so puzzles me. As, indeed, much of the US debate about health care puzzles me. I understand the idea that everyone should have access to the health care they need: indeed I share that thought. I can see various ways of getting from here to there. State financed for example, the much vaunted in certain circles "single payer" option. I can even see some of the merits of a single provider option like the NHS in my native UK. I also see problems with both those models as well.